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Seto B, Kodama K, Griffin D, Seto J, Obana K, Taira D. Effect of Hometown Seasonality on Undergraduate Students' Risk of Developing Seasonal Affective Disorder. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:298-303. [PMID: 34877542 PMCID: PMC8646863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Seasonal affective disorder (SAD) is a prevalent and potentially serious medical condition. Young adults are at particularly high risk. However, it is unknown if college students whose hometowns are in geographic areas with less seasonal variability, such as in the state of Hawai'i, are particularly vulnerable if they attend schools in areas with seasonal variability. An adapted version of the Seasonal Patterns Assessment Questionnaire (SPAQ) was administered to students at 3 universities to test this hypothesis. Surveys were administered twice: a baseline (T0) assessment in the fall and a follow-up (T1) assessment in the winter and were administered in the second month of each semester. A linear regression model was constructed to identify potential risk factors for developing seasonal fluctuations in mood (SPAQ scores T1-T0). Study subjects (n=115) from non-seasonal hometowns had a 1.6-point greater increase in SPAQ score than students from seasonal hometowns (-0.26 ± 3.88 vs 1.35 ± 3.03; P =.01). This difference is independent of demographic and lifestyle predictors (linear regression coefficient: β = 1.73; standard error = 0.68; P =.012). Interestingly, SPAQ score changes of students from seasonal hometowns did not differ significantly from 0 (t = -0.97; P =.33), indicating that they did not generally experience seasonal shifts in depressive symptoms. Students from less seasonal hometowns and counselors at seasonal institutions should be aware that these students could be more at risk of developing depressive symptoms and address these concerns before interfering with students' daily and academic lives.
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Affiliation(s)
- Brendan Seto
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (BS, KO)
| | - Kelsie Kodama
- Washington University School of Medicine, St. Louis, MO (KK)
| | - Danielle Griffin
- Department of Psychology, University of Maryland, Catonsville, MD (DG)
| | - Jason Seto
- The Queens Medical Center, Honolulu, HI (JS)
| | - Kyle Obana
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (BS, KO)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i, Hilo, HI (DT)
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Fonte A, Coutinho B. Seasonal sensitivity and psychiatric morbidity: study about seasonal affective disorder. BMC Psychiatry 2021; 21:317. [PMID: 34187417 PMCID: PMC8243845 DOI: 10.1186/s12888-021-03313-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal Affective Disorder is a recurrent depressive disorder which usually begins in the fall/winter and enters into remission in the spring/summer, although in some cases may occur in the summer with remission in the autumn-winter. In this study the authors evaluated the association between seasonal changes in mood and behavior with psychiatric disturbance. METHOD Descriptive, cross-sectional study. Participants, students attending higher education and vocational courses (N = 324), were evaluated with the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Screening Scale for Mental Health (ER80). RESULTS Among the respondents, 12.7% showed seasonal affective disorder (SAD), 29.0% showed subsyndromal seasonal affective disorder (s-SAD) and 58.3% did not show significant seasonal affective symptomatology. As for psychiatric morbidity, 36.6% of subjects with SAD and 13.8% of those with s-SAD were considered "psychiatric cases" whereas for subjects without SAD this value was only 3.2%. CONCLUSIONS There is a statistically significant association between psychiatric morbidity and seasonal affective disorder. This association corroborates the importance of the Seasonal Pattern Assessment Questionnaire in screening for seasonal fluctuations in mood and behavior related disorders, and the clinical need for recognition of these conditions, particularly associated suffering and disabilities.
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Affiliation(s)
- Aníbal Fonte
- Department of Psychiatry and Mental Health / Local Health Unit of the Alto Minho (ULSAM, EPE), Hospital de Santa Luzia, Estrada de Santa Luzia, 4901-858, Viana do Castelo, Portugal. .,Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University Porto, Porto, Portugal. .,CINTESIS-UP, Hospital de Santa Luzia, Estrada de Santa Luzia, 4901-858, Viana do Castelo, Portugal.
| | - Bruno Coutinho
- Local Health Unit of the Northeast (ULSNE, EPE), Bragança, Portugal
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Zghoul T. Can we prevent seasonal affective disorder (SAD) with melatonergic agents? BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSeasonal affective disorder (SAD) is a recurrent form of major depression, particularly occurring in the winter months with a generally spontaneous remission in spring/summer. The predictable nature of this condition provides a potentially unique opportunity to prevent recurrence in sufferers of SAD. The Cochrane Review discussed here examines the evidence for melatonin and agomelatine in preventing SAD, putting its findings into their clinical context.
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Wirz-Justice A, Ajdacic V, Rössler W, Steinhausen HC, Angst J. Prevalence of seasonal depression in a prospective cohort study. Eur Arch Psychiatry Clin Neurosci 2019; 269:833-839. [PMID: 30022319 DOI: 10.1007/s00406-018-0921-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/09/2018] [Indexed: 11/28/2022]
Abstract
The prevalence of autumn/winter seasonality in depression has been documented in the longitudinal Zurich cohort study by five comprehensive diagnostic interviews at intervals over more than 20 years (N = 499). Repeated winter major depressive episodes (MDE-unipolar + bipolar) showed a prevalence of 3.44% (5× more women than men), whereas MDE with a single winter episode was much higher (9.96%). A total of 7.52% suffered from autumn/winter seasonality in major and minor depressive mood states. The clinical interviews revealed novel findings: high comorbidity of Social Anxiety Disorder and Agoraphobia within the repeated seasonal MDE group, high incidence of classic diurnal variation of mood (with evening improvement), as well as a high rate of oversensitivity to light, noise, or smell. Nearly twice as many of these individuals as in the other MDE groups manifested the syndrome of atypical depression (DSM-V), which supports the prior description of seasonal affective disorder (SAD) as presenting primarily atypical symptoms (which include hypersomnia and increase in appetite and weight). This long-term database of regular structured interviews provides important confirmation of SAD as a valid diagnosis, predominantly found in women, and with atypical vegetative symptoms.
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Affiliation(s)
- Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Vladeta Ajdacic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland
- Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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Pidduck W, Wan BA, Zhang L, Chow S, Yee C, Chan S, Drost L, Sousa P, Lewis D, Lam H, Leung E, Chow E. Seasonal fluctuations in psychological distress amongst women diagnosed with early breast cancer receiving radiotherapy. Psychooncology 2019; 28:2091-2097. [PMID: 31410917 DOI: 10.1002/pon.5199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/05/2019] [Accepted: 07/15/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Seasonal effects on patients diagnosed with depression/anxiety-related psychological disorders have varying impacts on symptom severity. Seasonal changes in psychological distress may be due to decreased daylight exposure during the fall/winter seasons. Patients receiving radiation therapy (RT) for early-stage invasive breast cancer (EIBC) are at high risk for developing depressive symptoms. Of interest is whether seasonal factors influence the psychological symptoms of patients being treated for EIBC. METHODS Patients treated with RT for EIBC between January 2011 and June 2017 were identified. Patients who completed at least one Edmonton Symptom Assessment Scale (ESAS-r) pre-RT and post-RT were included in our analysis. Patients receiving RT during the autumn and winter (November-March) were compared with patients receiving RT during the spring and summer (April-August). Psychological distress was evaluated based on patient-reported depression, anxiety, and overall wellbeing on the ESAS-r. Data on systemic treatment and radiation were extracted from existing databases. RESULTS Eight-four patients treated with RT in spring/summer and 102 patients treated with RT in autumn/winter were included. Patients receiving RT during spring/summer had better wellness score prior to RT, compared with those receiving RT during winter/autumn (P = .03). However, patients receiving RT in the spring/summer had worse symptom trajectories across three domains of depression, anxiety, and wellbeing (P = .03, P = .008, and P < .0001, respectively). CONCLUSIONS Seasonality influenced the symptoms reported by patients with EIBC receiving RT. Future studies are needed to understand when during treatment patients are at highest risk for psychological distress and how seasonality may influence high-risk periods.
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Affiliation(s)
- William Pidduck
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bo Angela Wan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Selina Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caitlin Yee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leah Drost
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Philomena Sousa
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Donna Lewis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric Leung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Madsen H, Dam H, Hageman I. Eye disorder differentiates seasonality outcomes in persons with severe visual impairment. J Affect Disord 2017; 217:233-236. [PMID: 28432995 DOI: 10.1016/j.jad.2017.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/28/2017] [Accepted: 04/02/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Light plays a crucial role in both the pathogenesis and treatment of seasonal affective disorder (SAD). Consequently decreased retinal sensitivity to light has been suggested to be a risk factor for SAD. In a population of persons with severe visual impairment we recently found a highly increased prevalence of SAD. We now aimed to identify eye disorders or anatomical locations with specific association to seasonality. METHODS In 912 cases (33%) from our prior seasonal pattern assessment questionnaire (SPAQ) screening study, we retrieved eye diagnoses from the Danish National Patient Registry and analyzed for specific eye disorders or anatomical locations that significantly differentiated SPAQ outcomes (global seasonality score, (GSS) and SPAQ-SAD prevalence). RESULTS Persons with early life eye disorders (congenital conditions or retinopathy of prematurity) reported less symptoms of SAD (median GSS 4.5) than persons with acquired eye disorders (median GSS 5.0, p=0.005). Persons with macular degenerative disorders (MD) had highly increased seasonality outcomes (hazard ratio 2.23, p=0.002, median GSS 5 vs. 8, p=0.01). LIMITATIONS the study is a cross-sectional study based on a self-report questionnaire. Register data may be incomplete. CONCLUSIONS MD is significantly associated to high-level seasonality and SAD prevalence. Early life eye disorder is associated to slightly lower seasonality compared to acquired eye disorder. Longitudinal studies are needed to assess causality.
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Affiliation(s)
- Heller Madsen
- Mental Health Center Copenhagen, University of Copenhagen, Denmark.
| | - Henrik Dam
- Mental Health Center Copenhagen, University of Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Center Copenhagen, University of Copenhagen, Denmark
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Winkler D, Pjrek E, Spies M, Willeit M, Dorffner G, Lanzenberger R, Kasper S. Has the existence of seasonal affective disorder been disproven? J Affect Disord 2017; 208:54-55. [PMID: 27744127 DOI: 10.1016/j.jad.2016.08.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/19/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
| | - Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Matthäus Willeit
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Georg Dorffner
- Section for Artificial Intelligence and Decision Support, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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Meesters Y, Gordijn MC. Seasonal affective disorder, winter type: current insights and treatment options. Psychol Res Behav Manag 2016; 9:317-327. [PMID: 27942239 PMCID: PMC5138072 DOI: 10.2147/prbm.s114906] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Seasonal affective disorder (SAD), winter type, is a seasonal pattern of recurrent major depressive episodes most commonly occurring in autumn or winter and remitting in spring/summer. The syndrome has been well-known for more than three decades, with light treatment being the treatment of first choice. In this paper, an overview is presented of the present insights in SAD. Description of the syndrome, etiology, and treatment options are mentioned. Apart from light treatment, medication and psychotherapy are other treatment options. The predictable, repetitive nature of the syndrome makes it possible to discuss preventive treatment options. Furthermore, critical views on the concept of SAD as a distinct diagnosis are discussed.
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Affiliation(s)
- Ybe Meesters
- University Center for Psychiatry, University Medical Center Groningen
| | - Marijke Cm Gordijn
- Department of Chronobiology, GeLifes, University of Groningen, Groningen, the Netherlands; Chrono@Work B.V., Groningen, the Netherlands
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Jia Y, Zhu H, Leung SW. Comparative efficacy of selective serotonin reuptake inhibitors (SSRI) in treating major depressive disorder: a protocol for network meta-analysis of randomised controlled trials. BMJ Open 2016; 6:e010142. [PMID: 27267106 PMCID: PMC4908880 DOI: 10.1136/bmjopen-2015-010142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There have been inconsistent findings from randomised controlled trials (RCTs) and systematic reviews on the efficacies of selective serotonin reuptake inhibitors (SSRIs) as the first-line treatment of major depressive disorder (MDD). Besides inconsistencies among randomised controlled trials (RCTs), their risks of bias and evidence grading have seldom been evaluated in meta-analysis. This study aims to compare the efficacy of SSRIs by conducting a Bayesian network meta-analysis, which will be the most comprehensive evaluation of evidence to resolve the inconsistency among previous studies. METHODS AND ANALYSES SSRIs including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline and vilazodone have been selected. Systematic database searching and screening will be conducted for the RCTs on drug treatment of patients with MDD according to pre-specified search strategies and selection criteria. PubMed, the Cochrane Library, EMBASE, ScienceDirect, the US Food and Drug Administration Website, ClinicalTrial.gov and WHO Clinical Trials will be searched. Outcome data including Hamilton Depression Rating Scale (HDRS), Montgomery-Åsberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) from eligible RCTs will be extracted. The outcomes will be analysed as ORs and mean differences under a random-effects model. A Bayesian network meta-analysis will be conducted with WinBUGS software, to compare the efficacies of SSRIs. Subgroup and sensitivity analysis will be performed to explain the study heterogeneity and evaluate the robustness of the results. Meta-regression analysis will be conducted to determine the possible factors affecting the efficacy outcomes. The Cochrane risk of bias assessment tool will be used to assess the RCT quality, and the Grading of Recommendation, Assessment, Development and Evaluation will be used to assess the strength of evidence from the meta-analysis. ETHICS AND DISSEMINATION No ethical approval is required because this study includes neither confidential personal patient data nor interventions with patients. PROTOCOL REGISTRATION NUMBER CRD42015024879.
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Affiliation(s)
- Yongliang Jia
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Hongmei Zhu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Siu-wai Leung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- School of Informatics, University of Edinburgh, Edinburgh, UK
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Sandman N, Merikanto I, Määttänen H, Valli K, Kronholm E, Laatikainen T, Partonen T, Paunio T. Winter is coming: nightmares and sleep problems during seasonal affective disorder. J Sleep Res 2016; 25:612-619. [PMID: 27174375 DOI: 10.1111/jsr.12416] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/21/2016] [Indexed: 12/18/2022]
Abstract
Sleep problems, especially nightmares and insomnia, often accompany depression. This study investigated how nightmares, symptoms of insomnia, chronotype and sleep duration associate with seasonal affective disorder, a special form of depression. Additionally, it was noted how latitude, a proxy for photoperiod, and characteristics of the place of residence affect the prevalence of seasonal affective disorder and sleep problems. To study these questions, data from FINRISK 2012 study were used. FINRISK 2012 consists of a random population sample of Finnish adults aged 25-74 years (n = 4905) collected during winter from Finnish urban and rural areas spanning the latitudes of 60°N to 66°N. The Seasonal Pattern Assessment Questionnaire was used to assess symptoms of seasonal affective disorder. Participants with symptoms of seasonal affective disorder had significantly increased odds of experiencing frequent nightmares and symptoms of insomnia, and they were more often evening chronotypes. Associations between latitude, population size and urbanicity with seasonal affective disorder symptoms and sleep disturbances were generally not significant, although participants living in areas bordering urban centres had less sleep problems than participants from other regions. These data show that the prevalence of seasonal affective disorder was not affected by latitude.
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Affiliation(s)
- Nils Sandman
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland. .,Department of Psychology and Speech Language Pathology, Centre for Cognitive Neuroscience, Turku Brain and Mind Centre, University of Turku, Turku, Finland.
| | - Ilona Merikanto
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland.,Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Hanna Määttänen
- Department of Psychology and Speech Language Pathology, Centre for Cognitive Neuroscience, Turku Brain and Mind Centre, University of Turku, Turku, Finland
| | - Katja Valli
- Department of Psychology and Speech Language Pathology, Centre for Cognitive Neuroscience, Turku Brain and Mind Centre, University of Turku, Turku, Finland.,Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Skövde, Sweden
| | - Erkki Kronholm
- Department of Health, National Institute for Health and Welfare, Turku, Finland
| | - Tiina Laatikainen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Hospital District of North Karelia, Joensuu, Finland
| | - Timo Partonen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Paunio
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Pjrek E, Baldinger-Melich P, Spies M, Papageorgiou K, Kasper S, Winkler D. Epidemiology and socioeconomic impact of seasonal affective disorder in Austria. Eur Psychiatry 2016; 32:28-33. [PMID: 26802981 DOI: 10.1016/j.eurpsy.2015.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/16/2015] [Accepted: 11/21/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Seasonal affective disorder (SAD) is a subtype of recurrent depressive or bipolar disorder that is characterized by regular onset and remission of affective episodes at the same time of the year. The aim of the present study was to provide epidemiological data and data on the socioeconomic impact of SAD in the general population of Austria. METHODS We conducted a computer-assisted telephone interview in 910 randomly selected subjects (577 females and 333 males) using the Seasonal Health Questionnaire (SHQ), the Seasonal Pattern Assessment Questionnaire (SPAQ), and the Sheehan Disability Scale (SDS). Telephone numbers were randomly drawn from all Austrian telephone books and transformed using the random last digits method. The last birthday method was employed to choose the target person for the interviews. RESULTS Out of our subjects, 2.5% fulfilled criteria for the seasonal pattern specifier according to DSM-5 and 2.4% (95% CI=1.4-3.5%) were diagnosed with SAD. When applying the ICD-10 criteria 1.9% (95% CI=0.9-2.8%) fulfilled SAD diagnostic criteria. The prevalence of fall-winter depression according to the Kasper-Rosenthal criteria was determined to be 3.5%. The criteria was fulfilled by 15.1% for subsyndromal SAD (s-SAD). We did not find any statistically significant gender differences in prevalence rates. When using the DSM-5 as a gold standard for the diagnosis of SAD, diagnosis derived from the SPAQ yielded a sensitivity of 31.8% and a specificity of 97.2%. Subjects with SAD had significantly higher scores on the SDS and higher rates of sick leave and days with reduced productivity than healthy subjects. CONCLUSIONS Prevalence estimates for SAD with the SHQ are lower than with the SPAQ. Our data are indicative of the substantial burden of disease and the socioeconomic impact of SAD. This epidemiological data shows a lack of gender differences in SAD prevalence. The higher rates of females in clinical SAD samples might, at least in part, be explained by lower help seeking behaviour in males.
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Affiliation(s)
- E Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
| | - P Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - M Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - K Papageorgiou
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - S Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - D Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
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Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. DEPRESSION RESEARCH AND TREATMENT 2015; 2015:178564. [PMID: 26688752 PMCID: PMC4673349 DOI: 10.1155/2015/178564] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/01/2015] [Accepted: 11/10/2015] [Indexed: 12/12/2022]
Abstract
Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as "winter blues." Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ). Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD.
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Azorin JM, Adida M, Belzeaux R. Frequency and characteristics of individuals with seasonal pattern among depressive patients attending primary care in France. Gen Hosp Psychiatry 2015; 37:76-80. [PMID: 25467075 DOI: 10.1016/j.genhosppsych.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/30/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE High rates of bipolar disorder (BD) have been found among major depressives with seasonal pattern (SP) consulting in psychiatric departments, as well as among patients seeking primary care. As SP was reported to be common in the latter, the current study was designed to assess (a) the frequency and characteristics of SP among major depressives attending primary care and (b) the prevalence and aspects of BD in this population. METHODS Among 400 patients who consulted French general practitioners (GPs) for major depression between February and December 2010, 390 could be included in the study: 167 (42.8%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for seasonal pattern [SP(+)], whereas 223 (57.2%) did not meet these criteria [SP(-)]. The two groups were compared on demographic, clinical, family history and temperamental characteristics. RESULTS Compared to SP(-), SP(+) patients were more frequently female, married and with a later age at first depressive episode, and showed more atypical vegetative symptoms, comorbid bulimia and stimulant abuse. They also exhibited more lifetime depressive episodes, were more often diagnosed as having BD II and met more often bipolarity specifier criteria, with higher rates of bipolar temperaments and a higher BD family loading. Among SP(+) patients, 68.9% met the bipolarity specifier criteria, whereas 31.1% did not. Seasonality was not influenced by climatic conditions. The following independent variables were associated with SP: BD according to bipolarity specifier, female gender, comorbid bulimia nervosa, hypersomnia, number of depressive episodes and family history of substance abuse. CONCLUSIONS Seasonal pattern is frequent among depressive patients attending primary care in France and may be indicative of hidden bipolarity. Given the risks associated with both SP and bipolarity, GPs are likely to have a major role in regard to prevention.
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Affiliation(s)
- Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Marc Adida
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France
| | - Raoul Belzeaux
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France
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Abstract
Seasonal affective disorder is a subtype of other affective disorders. The most studied treatment is light therapy, although second-generation antidepressants are also an option. Grief reactions are normal for patients experiencing loss, and primary care providers (PCPs) should be aware of both the expected course of grief and the more severe symptoms that indicate complex grief. Adjustment disorder is a time-limited abnormal response to a stressor. PCPs can manage patients with adjustment disorder by arranging counseling, screening for suicidality, assessing for substance abuse, and ruling out other psychiatric diagnoses. At present there are no reliable data to suggest medication management.
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Affiliation(s)
- Justin Osborn
- Department of Family Medicine, University of Washington, 331 Northeast Thornton Place, Box 358732, Seattle, WA 98125, USA.
| | - Jacqueline Raetz
- Department of Family Medicine, University of Washington, 331 Northeast Thornton Place, Box 358732, Seattle, WA 98125, USA
| | - Amanda Kost
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA 98195, USA.
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15
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Kamstra MJ, Kramer LA, Levi MD, Wang T. Seasonally Varying Preferences: Theoretical Foundations for an Empirical Regularity. ACTA ACUST UNITED AC 2014. [DOI: 10.1093/rapstu/rau002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Abstract
Seasonal affective disorder, which is underdiagnosed in the primary care setting, is a mood disorder subtype characterized by episodic major depression that typically develops in winter when daylight hours are short. Patients with SAD experience increased morbidity and decreased quality of life. This article focuses on recognition and management of this condition. Light therapy is the preferred treatment for SAD because it is safe and easy to administer; light therapy may be combined with pharmacologic therapy. Cognitive behavioral therapy (CBT) also has a positive therapeutic effect when combined with light therapy and may help prevent SAD in subsequent seasons.
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17
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Winthorst WH, Post WJ, Meesters Y, Penninx BWHJ, Nolen WA. Seasonality in depressive and anxiety symptoms among primary care patients and in patients with depressive and anxiety disorders; results from the Netherlands Study of Depression and Anxiety. BMC Psychiatry 2011; 11:198. [PMID: 22182255 PMCID: PMC3280179 DOI: 10.1186/1471-244x-11-198] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about seasonality of specific depressive symptoms and anxiety symptoms in different patient populations. This study aims to assess seasonal variation of depressive and anxiety symptoms in a primary care population and across participants who were classified in diagnostic groups 1) healthy controls 2) patients with a major depressive disorder, 3) patients with any anxiety disorder and 4) patients with a major depression and any anxiety disorder. METHODS Data were used from the Netherlands Study of Depression and Anxiety (NESDA). First, in 5549 patients from the NESDA primary care recruitment population the Kessler-10 screening questionnaire was used and data were analyzed across season in a multilevel linear model. Second, in 1090 subjects classified into four groups according to psychiatric status according to the Composite International Diagnostic Interview, overall depressive symptoms and atypical versus melancholic features were assessed with the Inventory of Depressive Symptoms. Anxiety and fear were assessed with the Beck Anxiety Inventory and the Fear questionnaire. Symptom levels across season were analyzed in a linear regression model. RESULTS In the primary care population the severity of depressive and anxiety symptoms did not show a seasonal pattern. In the diagnostic groups healthy controls and patients with any anxiety disorder, but not patients with a major depressive disorder, showed a small rise in depressive symptoms in winter. Atypical and melancholic symptoms were both elevated in winter. No seasonal pattern for anxiety symptoms was found. There was a small gender related seasonal effect for fear symptoms. CONCLUSIONS Seasonal differences in severity or type of depressive and anxiety symptoms, as measured with a general screening instrument and symptom questionnaires, were absent or small in effect size in a primary care population and in patient populations with a major depressive disorder and anxiety disorders.
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Affiliation(s)
- Wim H Winthorst
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, The Netherlands.
| | - Wendy J Post
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, the Netherlands,Department of Pedagogy & Educational Sciences, University of Groningen, the Netherlands
| | - Ybe Meesters
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Brenda WHJ Penninx
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands,Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands,Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands
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18
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What is this thing called “SAD”? A critique of the concept of seasonal affective disorder. ACTA ACUST UNITED AC 2011; 17:120-7. [DOI: 10.1017/s1121189x00002815] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryBackground– Seasonal Affective Disorder (SAD) is supposed to be caused by lack of daylight in winter. Yet the population of Northern Norway, living without sun for two winter months, does not spontaneously complain about depression during the dark period.Aims– To summarize research bearing upon the validity of the concept of SAD.Method– Review of relevant literature concerning the epidemiology of SAD and the questionnaire developed to measure it in general populations, the Seasonal Pattern Assessment Questionnaire (SPAQ).Results– Large population studies from northern Norway do not point to a higher prevalence of depression in winter than expected in any other general population. The psychometric properties of SPAQ are rather poor, and the diagnosis of SAD based on SPAQ bears little relationship to a meaningful concept of depression.Conclusions– Seasonal Affective Disorder is not a valid medical construct. Instead, “Recurrent depression with seasonal pattern” as defined in the DSM-IV and the ICD-10 should be used as terms. However, more research is needed to establish whether it is at all fruitful to single out such a subtype of recurrent depression.Declaration of Interest: None.
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19
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Abstract
Seasonal affective disorder (SAD) is defined as a history of major depressive episodes that recur regularly at a particular time of year. Depending on the diagnostic instruments and criteria available, the reported prevalence (1%-10%) varies. Neurotransmitter abnormalities have been implicated in the pathophysiology, but they do not necessarily explain the seasonal pattern or the known chronobiological abnormalities in SAD compared with nonseasonal depression. Circadian rhythm abnormalies have been hypothesized to account for these aspects of SAD, and they provide a rationale for the therapeutic use of light therapy. Family history, twin, and molecular genetics studies suggest that hereditary factors are also involved. Light therapy and antidepressant medication are effective treatment options, with limited evidence for the efficacy of psychotherapy. Some studies demonstrate that narrow-band short wavelength "blue" light, naturalistic dawn simulation, and high-density negative air ionization are effective. Patients should be informed of the benefits of diet and exercise. Light therapy should be clinically monitored in the same manner, as it is done for other antidepressant treatments.
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Affiliation(s)
- Robert H Howland
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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20
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Kegel M, Dam H, Ali F, Bjerregaard P. The prevalence of seasonal affective disorder (SAD) in Greenland is related to latitude. Nord J Psychiatry 2009; 63:331-5. [PMID: 19306154 DOI: 10.1080/08039480902799040] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to determine the prevalence of seasonal affective disorder (SAD) in Greenlanders and Danes living at four different latitudes in Greenland. A Seasonal Pattern Assessment Questionnaire (SPAQ) was mailed to 6021 men and women between the ages of 18 and 59 years living in four different municipalities in Greenland. The recipients were randomly selected from the National Population Register. Approximately 9% of the respondents met the criteria for SAD, and the incidence of SAD varied between a southern municipality and three northern municipalities. The prevalence of SAD was particularly high in northern municipalities. No significant difference was found in the prevalence of SAD between Greenlanders and Danes. The results are comparable with other population studies that have reported a high prevalence of SAD in arctic areas. The clinical implications of our findings and the possibilities for introducing light therapy should be assessed in future studies.
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Affiliation(s)
- Mogens Kegel
- Department of Psychiatry, Ballerup, Ballerup Boulevard 2, Ballerup 2750, Denmark.
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21
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Rintamäki R, Grimaldi S, Englund A, Haukka J, Partonen T, Reunanen A, Aromaa A, Lönnqvist J. Seasonal changes in mood and behavior are linked to metabolic syndrome. PLoS One 2008; 3:e1482. [PMID: 18213390 PMCID: PMC2190794 DOI: 10.1371/journal.pone.0001482] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 12/19/2007] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obesity is a major public health problem worldwide. Metabolic syndrome is a risk factor to the cardiovascular diseases. It has been reported that disruptions of the circadian clockwork are associated with and may predispose to metabolic syndrome. METHODOLOGY AND PRINCIPAL FINDINGS 8028 individuals attended a nationwide health examination survey in Finland. Data were collected with a face-to-face interview at home and during an individual health status examination. The waist circumference, height, weight and blood pressure were measured and samples were taken for laboratory tests. Participants were assessed using the ATP-III criteria for metabolic syndrome and with the Seasonal Pattern Assessment Questionnaire for their seasonal changes in mood and behavior. Seasonal changes in weight in particular were a risk factor of metabolic syndrome, after controlling for a number of known risk and potential confounding factors. CONCLUSIONS AND SIGNIFICANCE Metabolic syndrome is associated with high global scores on the seasonal changes in mood and behavior, and with those in weight in particular. Assessment of these changes may serve as a useful indicator of metabolic syndrome, because of easy assessment. Abnormalities in the circadian clockwork which links seasonal fluctuations to metabolic cycles may predispose to seasonal changes in weight and to metabolic syndrome.
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Affiliation(s)
- Reeta Rintamäki
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
| | - Sharon Grimaldi
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
| | - Ani Englund
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
| | - Jari Haukka
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
| | - Timo Partonen
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
| | - Antti Reunanen
- Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
| | - Arpo Aromaa
- Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
| | - Jouko Lönnqvist
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
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22
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Abstract
The operational criteria for seasonal affective disorder (SAD) have undergone several changes since first proposed in 1984. SAD is currently included as a specifier of either bipolar or recurrent major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The International Classification of Diseases, Tenth Edition has provisional diagnostic criteria for SAD. The most characteristic quality of SAD is that the symptoms usually present during winter and remit in the spring. Furthermore, the symptoms tend to remit when the patients are exposed to daylight or bright light therapy. The cognitive and emotional symptoms are as in other types of depression but the vegetative symptoms are the reverse of classic depressive vegetative symptoms, namely increased sleep and increased appetite. SAD is a common condition, but the exact prevalence rates vary between different studies and countries and is consistently found to be more common in women and in youth. SAD probably possibly occurs in children although not as commonly as in young adults. Some studies have found that certain ethnic groups who live at high northern latitudes may have adapted to the long arctic winter.
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Affiliation(s)
- Andres Magnusson
- Department of Psychiatry, Aker University Hospital, Oslo, Norway.
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23
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Abstract
OBJECTIVE Bright light treatment is an established treatment for Seasonal Affective Disorder, but in non-seasonal depression research results have been contrasting. METHOD This study was designed as a 5-week controlled, double-blind, parallel trial in out-patients with a diagnosis (DSM-IV) of non-seasonal major depression, randomized to either active treatment (white light, 10 000 lux, 1 h daily) or placebo treatment (red light, 50 lux, 30 min daily) and concomitant treatment with sertraline in both groups. RESULTS One hundred and two patients were included in the study. Analyses showed that on all used scales the reduction in depression scores was larger in the bright light group than in the dim light group, and this reached statistical significance on all observer rating scales and on the SCL-90R self-assessment scale. The HAM-D6 was the most sensitive scale to measure improvement at endpoint. CONCLUSION The study results support the use of bright light as an adjunct treatment to antidepressants in non-seasonal depression.
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Affiliation(s)
- K Martiny
- Psychiatric Research Unit, Frederiksborg General Hospital, Hilleroed, Denmark.
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